A war in the House of Medicine: Can women physicians help?

A war is brewing in the House of Medicine. It’s a war of philosophy based on how we physicians approach our patients–the people who come to us to be cared for and to be cared about. The people who come as patients to the physician as healer, a healer who also has a wealth of scientific knowledge which can be used to stamp out disease and bring long, healthy lives to many more people than ever in the history of humankind.

There is no doubt that science has allowed us to save babies who have emerged from their mother’s womb months before the world is ready for them. It is that same science that has allowed centenarians to become commonplace, many of whom are highly active. And it that same science that has created technologies that have almost made it moot to actually touch the patient for a physical examination and now even an operation.

But it is also this science, based in “evidence” that is increasingly creeping into and undermining the patient-healer relationship. And it is not the science/evidence per se that is potentially harmful, but rather the fact that it is allowed to supplant, not supplement, the core of what should be a sacred relationship. It crowds out the physician as healer who cares about the patient as unique person.

Sticking with evidence alone, we lose sight of the personal. We look at images, numbers, and “objective evidence.” Patients want us to care about them as human beings. They want us to hear their voices, their concerns, their fears and their pain. Things not easily quantified and objectified. It’s a tall order, I will admit, but it is not impossible.

How can women help? Women physicians are in a unique position to change this patient care paradigm. Women are brought up with a different mind set. Relationships that share intimacies are very important to us as we grow up. And even though our schooling and training acculturates us to the medicine as science, many of us have rebelled against only doing business this way.

Here’s how. In general:

We take longer with patients.

We order fewer tests.

We do fewer procedures.

We interrupt less.

We ask more.

We hear more.

And for all of this we are called less productive. We are devalued for our style of relating to the patient, of tackling their problems.

The naysayer might ask, “Is there any proof that this approach will make a difference?” Yes, scientifically speaking there is the placebo effect, which can be measured and can be very strong. And so we must find other ways to show that our patients benefit from the healer in us so we can help to restore them to sound body and mind.

We have entered an era where evidence based medicine is constantly cited as the panacea for all that ails our healthcare system. Clearly it is not. It is limited because people are so uniquely different. And it is up to us to recognize each person’s unique humanity and try to connect to them so that they have hope, positive energy, and the feeling that their problems will at least be heard, and in a most perfect world, solved.

So, as relative newcomers to the House of Medicine, women have to re-emphasize the relationships that are necessary to form if we are to make the evidence most effective. Next steps: study these relationships, learn how women physicians work best, define our attitudes about patient care, and redefine what constitutes “productivity” for physician healers. And then there will be war no more.

A war in the House of Medicine: Can women physicians help? 11 comments

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Suzi Q 38

I will admit that I hear what you say.

If women physicians listen more, I am going to have to seek more of them out in the future.

I only have one, and she stares at the computer, and doesn’t have much in the way of people skills.

I had been complaining to my gyn/oncologist about my neuropathies that were apparent about 2-3 months after my hysterectomy.
He nodded, then put me off until the next visit.

After several errors, I have finally gotten to guts to tell this doctor off verbally over the phone. He apologized, and agreed that he needs to listen to his patients more.

I told him that he made so many errors that come Monday, the next phone call would have been to the patient advocacy department with a request to have my case reviewed by other doctors at his hospital.

I was so ill and angry that I was ready to report him to the state medical board.
I had never considered doing this before, but I guess I could learn.
It is amazing what I had to do to be heard.

My point is that not all doctors, male or female, listen.

In the end, I was O.K….only because I demanded that they listen.

LBENT

I hear you.

On average, women tend to listen better. This is not an absolute, of course.

My point is that the system has taken away what women excel in and don’t value these skills. We, as women physicians, have to change the dialogue and make sure that the healer in us is not lost.

There was a recent op-ed piece in the NY Times written by a chairwoman of a NYC university medical center anesthesiology department who bemoaned the major exit of women physicians from the profession ten years after completing their training. She made it clear that it had little to do with having or raising a family. There is a physician workforce shortage and we need to produce physicians who once experienced are going to stay in the profession and not depart. Before we increase the number of female physicians we need to find out why they are leaving and address those problems.
Saying female physicians are better listeners is as sexist a statement as I have heard in awhile. There are good listeners and poor listeners in the profession. If at the training level physicians are encouraged to be good listeners and develop people skills and if they are not punished economically for taking the time to listen and be empathetic and sympathetic , then the physicians you train will listen well and long and exhibit a better bedside manner. If evaluation and management skills including listening and caring continue to be undervalued then physicians , men and women, will speed up the visit and substitute well paid procedures and technology so they can pay the bills

LBENT

There is good research to show that women physicians interrupt their patients less often, are better atuned to their needs, and enjoy building relationships. It’s not sexist to point out differences. If that were the case it would be racist to point out the hypertension is more prevalent in black people.

I do agree with you that all physicians should be trained to be empathetic and to listen well. But you and I know that the selection process, the education and the training do not emphasize this aspect. And there is frankly little time when there are so many regulations, so many insurance companies to fight with to get care the patients need, and so much worthless documentation in EMRs to satisfy everyone that you really did the job for which you should be paid.

Your dichotomy of physicians who listen (i.e. medical doctors) vs. those who use technology and procedures (i.e. surgeons) is just as stereotypical as you claim mine is of women vs. men. My kindest doctors who have taken the most time to talk happen to be the surgeons. My internist just talks to me about numbers. She is good, but we haven’t yet connected on the relationship side.

http://www.thehappymd.com/ Dike Drummond MD

I would love to see any research basis for your assertions that women physicians take longer, interrupt less, ask more, hear more and order fewer tests and procedures. I am completely unaware of any such data of any kind.

And what is the “war’ you are speaking of. Seems to me you have an axe and are grinding it here, Dr. Brodsky.

Don’t project your own experience onto “medicine” and healthcare in general. I don’t think there is a battle of the sexes going on in the ranks of physicians. This is an inevitable and long overdue transition to bring more female energy to the practice of medicine … not a war for heaven’s sake.

“redefine what constitutes “productivity” for physician healers. And then there will be war no more”

Your bullets in this “war” (your word) can only be classified as friendly fire. All doctors, male and female, want to spend more time with their patients. The only ones who can change this are CMS and the insurers. Your resentment is misdirected.

LBENT

I use the common measures of productivity (patients seen, RVUs, procedures done), the ones that are “through put” measures. They are terrible ones, I agree.

http://twitter.com/KarenSibertMD Karen Sibert MD

Generalizing about women physicians is just sexism in another form. To imply that men often aren’t kind or patient is unfair and untrue, just as it would be to imply that women as a group are gossipy, flighty or bitchy.

A cynic might note that as the number of women physicians has increased exponentially over the past 30 years, so has the tendency to look at medical practice as shift work and to devalue the hard work and professionalism of past years that made American medicine great.

Women will have accomplished something when we can all look at the larger picture and forget gender.. My husband and I are both anesthesiologists; he’s one of the best I know. Sometimes a patient will express pleasure at having me provide anesthesia because I’m a woman. That’s sweet, but irrelevant. The issue should be whether or not I’m a good physician. It doesn’t make me any happier to have a patient focus on my appearance than it did back in the early 80s when patients assumed I was the dietician until proven otherwise.

I agree with southerndoc’s comments about the real culprits of time and production pressure: CMS, insurers and the government regulators who want more for less.

LBENT

Dr. Sibert, of course we cannot truly generalize about anything without facing the exceptions. In every research paper we use the mean and deviations from the mean and we generalize about a disease, always recognizing that there are variations, so talking about women physicians as a group

is not sexism. My observations and opinions are reality based on the studies of women in medicine thus far performed in the literature and my personal observations of women physicians for greater than 30 years.

You are dead wrong about the fact that you being a woman is irrelevant to that patient. Your sex might be very comforting to that patient. If you cannot give comfort, than you are indeed an automaton. My fondest memory was when I was holding the hands of and 8 year old as she was getting ready to undergo anesthesia. She said to me, you smell good, you smell like my grandmother. She was smiling. Her mother told me this at her post op. They made me a small gift. A scared child was comforted with a positive female memory. That is a big part of my job. And then I did my surgery.

30 years as a surgeon has taught me that there are many ways that women can re-define and re-shape the way medicine is practiced. The fact that you have bought into the current paradigm, hook, line and sinker does not bode well for the changes that we all must create if we are going to find better ways. I stand on my belief that those of us who look at relationship building as a key factor in caring for people, are going to be successful in changing the House of Medicine for the better. Linda Brodsky

kjindal

in order for women physician’s to “listen more” than their male counterparts (and btw, I completely disagree that this is the case), they first have to WORK! I think maybe 10% of the female graduates of my med school class are working, and those are almost completely part-timers.

LBENT

And what data do you have to support that only 10% are working? The AMA WPC survey of 2008, supported by many other surveys shows that the vast majority of women doctors work and that they work full time except during child bearing years, where variable numbers take time off. Do you work with any women physicians? We work hard, but we work differently.